Electrocardiographic activity before onset of postoperative atrial fibrillation in cardiac surgery patients.
BACKGROUND
Electrocardiographic (ECG) characteristics were analyzed in postoperative cardiac surgery patients in an attempt to predict development of new-onset postoperative atrial fibrillation (AF).


METHODS
Nineteen ECG characteristics were analyzed using computer-based algorithms. The parameters were retrospectively analyzed from ECG signals recorded in postoperative cardiac surgery patients while they were in the cardiovascular intensive care unit (CVICU) at our institution. ECG data from 99 patients (of whom 43 developed postoperative AF) were analyzed. A bootstrap variable selection procedure was applied to select the most important ECG parameters, and a multivariable logistic regression model was developed to classify patients who did and did not develop AF.


RESULTS
Premature atrial activity (PAC) was greater in AF patients (P < 0.01). Certain heart rate variability (HRV) and turbulence parameters also differed in patients who did and did not develop AF. In contrast, P-wave morphology was similar in patients with and without AF. Receiver operating curve (ROC) analysis applied to the model produced a C-statistic of 0.904. The model thus correctly classified AF patients with more than a 90% sensitivity and a 70% specificity.


CONCLUSIONS
Among the 19 ECG parameters analyzed, PAC activity, frequency-domain HRV, and heart rate turbulence parameters were the best discriminators for postoperative AF.
Ovreiu
Mirela
M
Department of Clinical Engineering Research, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Nair
Bala G
BG
Xu
Meng
M
Bakri
Mohamed H
MH
Li
Liang
L
Wazni
Oussama
O
Fahmy
Tamer
T
Petre
John
J
Starr
Norman J
NJ
Sessler
Daniel I
DI
Bashour
C Allen
CA
D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity